Peer Reviewed Articles Medical Cannabis for Opiate Addiction

• Enquiry
• Open Access
• Published: 28 Jan 2019

Medical cannabis patterns of use and exchange for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit substances; results from a cantankerous-sectional survey of authorized patients

• Eric P. Baron^iv &
• Nick Jikomes⁵

Harm Reduction Journal volume 16, Article number:9 (2019) Cite this commodity

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Abstract

Background

A 239-question cantankerous-sectional survey was sent out via email in January 2017 to gather comprehensive data on cannabis use from Canadian medical cannabis patients registered with a federally authorized licensed cannabis producer, resulting in 2032 consummate surveys.

Methods

The survey gathered detailed demographic data and comprehensive information on patient patterns of medical cannabis use, including questions assessing the self-reported affect of cannabis on the employ of prescription drugs, illicit substances, booze, and tobacco.

Results

Participants were 62.6% male person (northward = 1271) and 91% Caucasian (due north = 1839). The mean historic period was xl years erstwhile, and pain and mental health conditions accounted for 83.seven% of all respondents (due north = 1700). Then, 74.six% of respondents reported daily cannabis apply (n = 1515) and mean amount used per mean solar day was 1.5 g. The virtually commonly cited substitution was for prescription drugs (69.1%, n = 953), followed by alcohol (44.5%, due north = 515), tobacco (31.1%, n = 406), and illicit substances (26.6%, n = 136). Opioid medications accounted for 35.3% of all prescription drug commutation (northward = 610), followed by antidepressants (21.v%, n = 371). Of the 610 mentions of specific opioid medications, patients report total cessation of use of 59.3% (northward = 362).

Conclusions

This study offers a unique perspective by focusing on the use of a standardized, government-regulated source of medical cannabis by patients registered in Canada's federal medical cannabis program. The findings provide a granular view of patient patterns of medical cannabis use, and the subsequent cocky-reported impacts on the use of opioids, booze, and other substances, adding to a growing body of academic enquiry suggesting that increased regulated access to medical and recreational cannabis tin can consequence in a reduction in the use of and subsequent harms associated with opioids, alcohol, tobacco, and other substances.

Background

Cannabis is the most widely used illicit substance in the earth [1, 2]. Its use has been associated with both personal and social benefits likewise as harms [2, 3]. While research supports the therapeutic use of cannabis in the treatment of chronic pain and other conditions [4,5,half-dozen,7,8], a comprehensive examination of the public health and safety impacts of cannabis needs to consider the growing body of prove suggesting its use affects the use of potentially more problematic legal substances similar booze and tobacco, and illicit substances like cocaine, heroin, and other opioids.

Bachhuber et al. (2014) report that US states with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality charge per unit compared to states without medical cannabis laws (95% CI − 37.5% to − 9.5%, p = .003), and this trend strengthened over time. An exam of opioid positivity in fatally injured drivers in the USA establish that land-based medical cannabis programs were associated with lower rates among 21 to xl year olds, with the authors final that regulated access to medical cannabis may reduce opioid apply and associated overdoses [9]. More recently, a cantankerous-sectional study of state implementation of medical and adult-use cannabis laws from 2011 to 2016 found that medical cannabis laws were associated with a 5.88% lower charge per unit of opioid prescribing [10].

Boosted population-level inquiry has explored how the recent introduction of regimes for legal access to cannabis (due east.thousand., medical and/or recreational) in some Usa states has preceded reductions in homicides and fierce crime [eleven], suicides [12], and automobile-related fatalities [13, 14], with all theorizing that these public health and condom benefits are related to subsequent declines in alcohol apply.

However, cannabis employ is not without potential harms. Chronic utilize has been associated with potential neurocognitive impairments especially in adolescent utilize, and the psychoactive furnishings of use and associated harm can lead to increased personal health and public safety risks associated with driving [fifteen, 16]. While evidence suggests that smoking as a route of administration may increase the gamble of bronchial issues [17, 18], the evidence in regards to associations between cannabis smoking and cancer is inconclusive. While some enquiry has establish a moderate increased chance of lung cancer in heavy users [xix, 20], other studies accept concluded that no causal clan exists [17, 18, 21, 22]. It is of import to note that the literature describing adverse events of cannabis including cardiovascular or cerebrovascular events is based on cannabis use from the blackness marketplace without standardized quality command. Thus, these reports are based on cannabis of unknown quality, toxins, heavy metals, fungal/bacterial elements, strains, cannabinoid and terpene profiles, illicit drug apply (laced cannabis or simultaneous use), concurrent prescription drug use, underlying patient medical history such every bit vascular run a risk factors, and many other cofounders which can influence adverse events.

There may also be some vulnerable populations in which risks are increased, such as women who may exist pregnant, although the limited literature examining impacts of cannabis use on pregnancy is clouded by contradictory findings [23, 24]. Youth may be at greater risk since cannabis may have more significant cognitive and psychological impacts on developing brains [25, 26], and those with a pre-disposition for psychosis or schizophrenia may exist particularly vulnerable since cannabis may perpetuate and potentially beal these conditions [27,28,29].

Social harms associated with cannabis include the impacts of impairment on driving [30, 31], and financial impacts on health care and police force, courtroom and incarceration costs resulting from prohibition [16, 32,33,34]. Some of the health-related harms and associated costs may be increased by the electric current international prohibition on cannabis, which leaves control over cannabis production and distribution to the black market. This criminal justice approach to cannabis regulation results in the criminalization of cease-users, and consumers purchasing cannabis products of unknown authority, with no quality controls or age restrictions on admission [2, 35, 36], making it challenging to study the bodily impacts of cannabis use on individuals without significant confounders related to both prohibition and the black-market control over product and distribution.

Recently, these negative policy-related outcomes have led many jurisdictions to try culling regulatory approaches, including the legalization of medical cannabis use in Canada and much of Latin American and the Eu, and the regulation of recreational adult use in a number of US states, Canada, and Uruguay. This study provides a unique perspective by focusing on the use of a standardized, authorities-regulated source of medical cannabis past patients registered in Canada's federal medical cannabis program. The findings provide a more granular view of patient patterns of medical cannabis employ, and the subsequent cocky-reported impacts on the use of opioids, alcohol and other substances.

Medical cannabis in Canada

In response to legal recognition of the ramble rights of Canadians to admission cannabis for medical purposes, in 2001, Canada became 1 of the outset nations in the world to establish a national medical cannabis program [37, 38]. The Marihuana Medical Access Regulations (MMAR) immune patients with chronic or incurable medical conditions like cancer, MS, HIV/AIDS, and severe chronic pain to utilise to Health Canada for permission to possess a express amount of medical cannabis, and in 2003 Wellness Canada began to provide patients with access to a legal source of flower cannabis consisting of a single cultivar produced under a federal contract and shipped to patients via post [37].

The programme has undergone numerous changes since its initiation due to shifts in policy and in response to successful legal challenges by patients who constitute the programme inadequate in addressing their medical needs [39, twoscore]. This culminated in the institution of the Marihuana for Medical Purposes Regulations (MMPR) in 2014, and ultimately in the Access to Cannabis for Medical Purposes Regulations (ACMPR) in August 2016 [37]. I of the primary changes of the MMPR/ACMPR was the authorisation of multiple licensed producers (LPs) of cannabis. Under the ACMPR, patients get cannabis recommendations from physicians or nurse practitioners without the past restrictions on medical atmospheric condition found in the MMAR, and can and so grow a limited amount of their ain cannabis and/or access it from LPs, who ship it straight to patients via mail service [38, 41]. As of September 2018, in that location were over 130 federally authorized licensed producers providing hundreds of strains of cannabis likewise as cannabis extracts like oils or capsules to approximately 342,103 patients [42]. Under the ACMPR, health care providers (HCPs) make a written recommendation of the amount of cannabis that patients are authorized to use and ultimately possess in "grams per day"; it is the responsibility of each LP to determine the quantity of cannabis oil that is equivalent to ane g of stale cannabis [42]. While some HCPs provide restrictions in regards to the say-so or blazon of cannabis patients may lodge from LPs and subsequently use, no condition-specific clinical guidelines have been adult yet, and patients are typically free to society and utilize whatever type of cannabis (i.e., specific cultivars, potencies, or types of cannabis products) they feel may work best in addressing their medical weather or symptoms [37, 41, 43].

As function of the ACMPR, Wellness Canada keeps detailed records of the amount of cannabis produced and distributed to patients; however, at that place is very little data on what conditions or symptoms touch on these patients, how they use cannabis products (i.e., type of product/manner of apply, frequency and dosages), and the impact of that use on the employ of prescription medications, alcohol, tobacco, and other substances.

Methods

In the involvement of learning more than about why/how patients use medical cannabis and whether this utilise affects the use of other substances, a 239-question patient feedback questionnaire was designed to assemble comprehensive data on patient demographics, patterns of cannabis use, admission to cannabis, and cannabis substitution effect from 2000 Canadian medical cannabis patients registered with Tilray, a federally authorized medical cannabis production, distribution, and research visitor located in Nanaimo, BC. This presented a unique cohort of cannabis users to assess, since they accessed a quality-tested, standardized cannabis supply under the auspice of a legal, tightly regulated medical cannabis authorities.

The principal objectives of the Tilray Patient Survey 2017 were to:

1. one.

   Draw the characteristics of the sample, including patient demographics, use of cannabis, prescription drugs, alcohol, tobacco, and illicit substances.

2. 2.

   Appraise the extent to which cannabis is used every bit a substitute for prescription drugs, alcohol, tobacco, and illicit substances, and differences in the extent of substitution amid the most frequently used drugs.

3. iii.

   Assess the extent to which commutation is mediated by age, gender, primary medical condition/symptoms, cannabis strains, and method of use.

This survey was ethics reviewed and approved past Advarra (formerly Institutional Review Board Services), and the University of Victoria subsequently approved a post-survey sub-analysis of the substitution data. Data gathering was done on REDCap, a HIPAA, and PIPEDA compliant electronic data capture system. HIPAA (Health Insurance Portability and Accountability Deed of 1996) is United states legislation that provides data privacy and security provisions for safeguarding medical information, and PIPEDA is the Canadian federal privacy law governing individual-sector organizations.

Participants were adult federally authorized medical cannabis patients registered with Tilray that provided the company with an e-mail address, were capable of reading and understanding French or English, and were able to legally consent to participate in the study.

A password-protected link to an online survey available in French and English language was sent out to xvi,675 Tilray patients. Clicking on the link in the email invitation took patients to the IRB-approved informed consent form (ICF), and consent was gathered electronically. All questions were gear up to "must provide value", so all questionnaires were fully answered with the exclusion of questions not relevant to individual respondents (i.e., if patients never used tobacco, then questions re. tobacco substitution were programmed not to appear via REDCap's "skip logic" role). To recoup patients for taking the time to respond and share their experiences, Tilray offered a $x credit on future cannabis purchases to all patients who completed the survey. The report upkeep of $20,000 allowed for the gathering of up to 2000 responses, and the survey deliberately airtight after gathering 2032 complete responses (32 participants were in the process of completing the survey when this cut off was met and then they were permitted to finish, resulting in 2032 complete surveys).

Measures

The survey was composed of multiple choice, ranking, and open up-ended questions to gather demographic data, health-related information, and details on medical cannabis employ and its impact on the utilize of other substances. A question regarding chief condition provided a selection of 21 common medical weather for which patients chose to utilise cannabis, and participants could only click one box (or click other and provide details in a text box), just a follow-upwards question regarding primary symptoms allowed participants to click multiple boxes from a pick of 13 common symptoms (or to click other and provide details in a text box). This allowed for a broader analysis of why patients specifically use medical cannabis in the treatment of unlike conditions; for example a participant citing MS every bit a main condition might study use of cannabis to accost insomnia, hurting, and spasticity under primary symptoms.

A comprehensive assessment of cannabis use included questions on frequency of apply per day and per week; yesterday use; amount used per session of apply, too as per solar day and per week; methods of ingestion (Vaporizer—cannabis flowers/bud; Oral (edibles such as oil drops/extracts, baked goods, butter, tincture), Articulation; Pipage; Waterpipe/bong; Vaporizer/nail/vape pen—cannabis extracts (shatter, budder, oil, etc.); Topical (on the peel; east.g., lotions/salves, etc.); Juicing (4, 0.two%); Other (please specify)); preferred cannabis flower diverseness as classified by Tilray (either indica, sativa, hybrid, one:1 CBD/THC, 3:ane CBD/THC); and favorite cultivar/strain with a driblet-downwards menu of all 37 cultivars or composite milled flower available from Tilray to that point, and an "other" option with an additional textual response. Those who acknowledged use of Tilray extract products (oil-based drops or capsules) were asked about their preferred type of extract equally labeled by the producer (indica, sativa, hybrid, 1:1 CBD/THC, 3:1 CBD/THC), frequency of apply per mean solar day, and whether or non they also used flower, and if so, what pct of their use was flower vs. extract in a quintile range from x% bloom/90% extract to 10% extract/90% flower. Participants were as well asked to rank their current level of cannabis knowledge from 0 to 100, with 1 existence no cognition and experience at all, and 100 being very knowledgeable and experienced.

In order to assess exchange, participants were asked if they "always regularly used or currently use" whatsoever of the following 4 classes of drugs: prescription drugs, alcohol, tobacco, and illicit substances. Those who responded positively were then asked if they had ever used cannabis every bit a substitute for these substances. Those that responded positively to exchange for either prescription drugs or illicit drugs were then asked to proper name up to 3 specific drugs they substituted for, and then asked at what percent they substituted cannabis for each specific drug by choosing from the post-obit options in a multiple choice, single-answer: 100% (Stopped using this drug completely); 75% (Reduced my use of this drug by 3/4); fifty% (Reduced my utilise of this drug by half); 25% (Reduced my utilize of this drug by ¼).

For both booze and tobacco, participants who responded positively to substitution were so asked at what quartile percent they substituted via the same multiple choice used to assess the cocky-reported charge per unit of substitution for prescription and illicit substances highlighted to a higher place.

Assay

Primary analysis for this study was done on SPSS. Objective 1 was assessed using descriptive statistics (frequencies) to depict the characteristics of the sample. The distribution of the qualitative responses for other in both the primary condition and primary symptoms questions were examined and recoded if they friction match with the listed conditions; otherwise, they were left as other. Corporeality of flower cannabis was determined by examining cocky-reported cannabis use per calendar week in grams, and extract utilise by frequency of daily and weekly employ ("times per twenty-four hours" × "days per week" use).

Objective 2 was assessed using descriptive statistics to quantify the degree of substitution based on quartiles from 25 to 100%. Several independent frequencies were conducted for the percent of substitution from 0 (recoded to 0, if no other percentage is given) to 100, restricted only to those who reported any regular lifetime use for each substance. Analyses recoded the prescription drugs into logical sub-categories (i.e., opioids, benzos, antidepressants, muscle relaxants, etc.), too as the illicit substances (i.e., cocaine/crack cocaine, opioids, stimulants, psychedelics, etc.).

Objective 3 was assessed using bivariate logistic regression analyses for substitution effect of each major drug (i.e., opioids, alcohol, tobacco, and illicit substances), which were recorded as dichotomous variables (DVs). Medical status/symptoms (i.east., pain, mental health) were reduced into a smaller number of logical groupings—arthritis/musculoskeletal and headache were grouped with chronic pain to form a broader chronic hurting category, and PTSD was grouped with mental health to create a broader mental health primary condition category, and stress, feet, depression were grouped to create a broader primary symptoms category—and treated as categorical IVs. Similarly, cannabis flower varieties and extracts were grouped to best reflect THC/CBD ratios ranging from "high THC/low CBD" to "High CBD/low THC".

Results

The hateful age of the sample was 40 years old, 1271 of which identified equally male (62.6%), 758 female person (37.3%), and 3 as Other (non-binary, transmasculine) (0.15%). In terms of marital status and racial backgrounds, 54.five% were married or in domestic partnership (n = 1107), and 91% (due north = 1839) identified as Caucasian; 6% [122] Metis/Beginning Nations, ii% [37] S Asian, and ii% [35] Asian. This was a highly educated population compared to the Canadian General Population (CGP); 93% (northward = 1893) of participants had a high school caste (compared to 87% CGP) and 22% (due north = 444) had a university caste or higher (compared to 17% of CGP) [44]. In regards to employment status, 63% of participants worked total time or part time (n = 1276), and nineteen% were disabled/not able to work (n = 384). In terms of income, participants were most identical to the CGP: half dozen.6% made less than $ten,000 (n = 135; CGP = 5%), 25.6% made $10,000–$39,999 (northward = 521; CGP: 27%), 42% made $xl,000–$99,999 (north = 852; CGP: 42%), and 26% made $ > 100,000 (n = 524; CGP: 26%) [44].

Primary condition and symptoms

In terms of master condition and main symptoms, hurting and mental wellness conditions were dominant, as seen in Table 1 and Tabular array 2, respectively. For primary condition, chronic hurting was reported by 29.4% (n = 598), and mental health condition was reported by 27% (n = 548). This was followed past insomnia (ix.7%, n = 198), arthritis/musculoskeletal (9.three%, northward = 188), PTSD (4.vi%, n = 93), and headache (3.7%, due north = 75). In all, pain and mental health conditions—PTSD, mental health, insomnia, chronic pain, arthritis, headache—accounted for 83.7% of all respondents (n = 1700).

Tabular array one Main conditions treated with medicinal cannabis

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Table ii Master symptoms treated with medicinal cannabis

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In regards to primary symptoms, chronic hurting was reported past 58.3% (n = 1184), followed by anxiety (48.8%, n = 991), insomnia (46.2%, n = 939), stress (45.eight%, n = 929), and depression (37.viii%, n = 767).

Cannabis use

In regards to cannabis use, 74.6% (due north = 1515) reported daily use, with a median of twice a twenty-four hour period use (25.1%, due north = 511). Across all main conditions, the majority of patients reported using cannabis on a daily footing (7 days/week), as seen in Tabular array 3. Mean amount used per day was ane.five g, with 78.v% (n = 1595) of participants reporting they utilize less than 3 g per day, and 9.9% (northward = 201) reporting they use four g or more per day.

Tabular array 3 Frequency of daily cannabis apply across all primary conditions

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In regards to primary method of use, vaporizer (cannabis flowers/bud or nail/pen) was cited by 31.i% (due north = 632), followed by articulation (30.4%; n = 617), oral/edible (16.3%, n = 332), pipe (11.iii%, n = 229), waterpipe/bong (10.4%, n = 212), topical (0.three%, n = half-dozen), and juicing (0.2%, due north = 4). This means that while inhalation via vaporization and/or smoking was by far the most pop methods of employ, accounting for 83.2% (n = 1690), non-smoked methods of apply (oral ingestion, topical, and vaporization) accounted for nearly half (47.6%, north = 968) of the primary methods of use.

In regards to bloom cannabis ("bud"), 32% preferred hybrids (north = 651), 28% preferred indicas (due north = 569), 24.vii% preferred sativas (northward = 502), and 14.eight% preferred loftier cannabidiol (CBD) strains (1:one CBD/THC or greater CBD content) (n = 300), with 0.49% (due north = 10) citing no preference. This suggests that when smoking or vaporizing cannabis—which is what patients do with cannabis flower—a significant majority (84.seven%; n = 1722) prefer strains loftier in THC.

Still, this was not the case with orally ingested oils/extracts. Overall, 38.5% of respondents used orally ingested cannabis oils/extracts (n = 782), with 49.ii% citing they mostly used high CBD oils/extracts (northward = 381). Oils/extracts were used with a lower frequency than blossom, with only 29.v% reporting daily use (northward = 226), and the median frequency of employ per solar day beingness once per day (65.half dozen%; n = 497). Additionally, 66.v% of those who reported using oil/extracts also used blossom on the same day (northward = 514), with a breakdown of 10% extract/90% blossom for 45.1% (due north = 230), 25% extract/75% flower for 23.three% (n = 119), 50% extract/fifty% flower for sixteen.v% (due north = 84), 75% extract/25% blossom for nine.6% (n = 49), and xc% extract/10% flower for 5.5% (northward = 28). Therefore, for most participants, oils/extracts announced to be adjunct treatments to the smoking or vaporization of cannabis flower.

When participants were asked to rank their electric current level of cannabis knowledge from 0 to 100 (with one being no noesis and experience at all, and 100 being very knowledgeable and experienced), the hateful was 73.65 (SD21.81). Interestingly, neither historic period nor income were significantly associated with unlike levels of cognition, but there was a meaning linear correlation (r = 0.29) with grams consumed per week and self-reported cognition level, and higher knowledge levels were more probable to use vape pens and water bongs, while lower levels of knowledge were more probable to use oral/extracts (p > .05), suggesting that naïve or less experienced cannabis users may have had a greater level of condolement with not-inhaled, orally-ingested modes of ingestion.

Substitution for other substances

The most commonly cited substitution was for prescription drugs (69.i%; n = 953), followed past alcohol (44.5%; due north = 515), tobacco (31.1%; n = 406), and illicit substances (26.6%; due north = 136), as seen in Tabular array 4. Overall, women were more than likely to report substitution than men (p < .01; 95% CI).

Tabular array 4 Drugs substituted with cannabis

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Participants named a total of 1730 specific prescription drugs they substituted cannabis for, 35.iii% (n = 610) of which were opioids, 21.v% (n = 371) anti-depressants, 10.9% (n = 189) non-opioid pain medications, viii.6% (n = 149) anti-seizure medications, viii.i% (due north = 140) muscle relaxants/sleep aids, 4.three% (due north = 75) benzodiazepines, 3.4% (due north = 59) stimulants, ane.4% (n = 24) anti-emetics, and 1% (n = 18) anti-psychotics, as seen in Tabular array 5. Of the 610 mentions of opioid medications, participants self-reported they stopped using 59.3% completely (100% exchange) (n = 362), and a further 18.4% reduced their use by 75% (n = 112). Participants who substituted for opioids used more cannabis per 24-hour interval (i.71 chiliad vs. 1.46 g by those who did non cite substitution for opioids) and were likewise more probable to report extract/oral utilise as their chief method of use (21%; north = 458 vs. 15%; n = 1574; p = 0.01) and to use extracts on a daily basis (40%; n = 187 vs. 26%; northward = 580; p = 0.004). In ranking reasons for substituting cannabis for prescription drugs, the reason ranked as the "most important" past the highest number of participants was the belief that cannabis is a safer alternative than prescription drugs (ranked #1 by 51.2%; n = 419), followed by fewer adverse side-furnishings (39.7%; n = 207), better symptom management (19.5%; n = 124), fewer withdrawal symptoms (11.four%; n = 61), the power to obtain cannabis vs. prescription drugs (3%; due north = 18), and social acceptance of cannabis is greater than prescription drugs (two.4%; n = 17).

Table 5 Breakdown of drugs substituted with cannabis

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Of the 515 respondents who substituted cannabis for alcohol, 30.ix% suggested they stopped using information technology completely (100%) (n = 159), and 36.7% reported reducing by at least 75% (due north = 189). Participants who reported mental health symptoms were more than likely to substitute for alcohol (n = 834; p = .0005), whereas participants who reported pain symptoms were less likely to substitute for alcohol (northward = 761; p = .002).

Of the 406 participants who substituted cannabis for tobacco, 50.7% say they stopped using information technology completely (100% substitution) (northward = 206), and 13.8% reported reducing their utilise by 75% (n = 56). Those who substituted for tobacco were far more than likely to fume cannabis as their primary method of apply (66% vs. 48% of those who did not substitute for tobacco; p < .0001). A more detailed assay of the tobacco substitution information from this study is the bailiwick of a separate publication.

In regards to illicit substances, cocaine/crack was the most ofttimes substituted illicit drug (17.4%; n = 89), followed by psychedelics (11.7%; due north = lx), non-prescription opioids (5.7%; due north = 29), stimulants (2.7%; n = 14), and depressants (1.6%; n = 8), equally seen in Table 5. Of those who cited substituting for illicit substances, 72.2% suggested they substituted at 100% for that specific drug mentioned (n = 332).

Discussion

This study represents the largest polling of Canadian medical cannabis patients to date, and the first broad survey of cannabis patients that we are aware of that has gathered such a detailed inventory of cannabis exchange for other drugs, including the specific prescription and illicit substances being substituted for, and the self-reported rate of that exchange as identified in quartile percentages, significantly improving the overall understanding of medical cannabis utilize and its bear on on the utilize of opioids, alcohol, and other substances.

The finding that cannabis was existence used for the treatment of chronic hurting is in keeping with past research [45, 46], but the growing utilize to treat mental health atmospheric condition like feet, stress, and depression suggests an emerging trend in medical cannabis use [38, 47]. Despite ongoing concerns in regards to the bear on of cannabis use past those with a predisposition for psychosis and schizophrenia [47, 48], the use to address more than modest just widespread mental health atmospheric condition represents a potential broadening of therapeutic applications and a skillful target for farther research [47, 49, fifty].

The high frequency of daily apply (74.6%) may suggest an area of concern in terms of potential long-term impacts on physical and mental wellness, but it is likely a reflection of the high charge per unit of use for pain and mental health atmospheric condition, both of which are chronic weather with daily traditional pharmacological handling options. While daily use may pose a gamble of dependence in some patients, enquiry suggests a low take a chance overall. In a 2015 study titled Land of the Evidence; Cannabis Utilise and Regulation, the International Heart for Science in Drug Policy assessed the state of evidence regarding the potential harms of cannabis use. They found the lifetime utilise of cannabis carried a depression chance of dependence (ix%), while the lifetime risk of dependence to booze has been assessed at 22.7%, and the lifetime risk of heroin dependence is estimated to exist between 23.1 and 35.5% [51].

Additionally, while 52.iv% of respondents cited smoking equally a primary route of administration, which could result in bronchial harms [18, 22], this information also suggests an ongoing trend away from the smoked ingestion of high THC products and toward vaporization and the oral ingestion (oils or capsules) of high CBD extracts (oil or capsules) [37, 38]. This is likely due to an increase in non-smoked product options available to patients via the ACMPR, a growing awareness of the potential therapeutic benefits of CBD (specially in regards to the handling of mental health conditions), and a more wellness-conscious approach to medical cannabis use overall. However, with more than and more patients around the globe using cannabis for medical purposes, prospective studies will exist necessary to assess the long-term health implications of chronic daily medical use, inform therapeutic considerations past patients and health care providers, and develop evidence-based handling guidelines.

This study's findings on the cocky-reported reduction of opioid use are especially significant to public wellness and safety. The past decade has seen the rapid growth of an opioid epidemic in N America, and currently drug overdose is the leading crusade of accidental death in Canada and the U.s.a., with many of these deaths resulting from both prescription and illicit opioids. In 2015, there were 52,404 drug overdose deaths in the USA, including 33,091 (63.1%) overdose deaths related to opioids [72]. In Canada, information technology is estimated that 4000 people died of an opioid overdose in 2017, 1450 of which were in British Columbia alone [52], and opioid overdose at present results in an average of sixteen hospitalizations per day, a 53% increase in opioid-related hospitalizations over the last x years [53]. Cannabis may not only reduce the prescription and use of opioids in medical and not-medical users [45, 54,55,56], information technology may also reduce the odds of transitioning to more than problematic substances and patterns of use. Reddon et al. (2018) plant that daily cannabis use was associated with slower rates of injection drug initiation among street youth in Vancouver (adjusted relative hazard 0.66, 95% confidence interval 0.45–0.98; p = 0.038) [57]. Furthermore, recent show suggests that cannabis use may reduce opioid withdrawal and improve outcomes of opioid-replacement therapies (methadone/Suboxone) for those seeking treatment for opioid utilise disorder [57,58,59,lx], thereby reducing the public wellness impacts of the current opioid overdose crisis.

Concurrent with the policy trend toward the regulation and legalization of both medical and adult recreational use in many US states, Canada, and effectually the globe is an urgent need to develop mechanisms to systematically track both the positive and negative impacts of cannabis apply on individuals and society. Nonetheless, this report suggests that regulating access to a standardized, quality-controlled source of cannabis for authorized patients may provide an opportunity to both reduce the harms associated with cannabis use, and to maximize the potential positive impacts on public health and rubber stemming from cannabis substitution upshot. Future studies involving standardized, quality-controlled cannabis will besides provide more accurate assessments of not only benefits of cannabis, just potential side effects and adverse events as well.

Strengths and limitations

This study has a number of strengths and limitations. Budgetary restrictions resulted in deliberately cutting off the survey at 2032 participants, leaving open the possibility this could exist an unrepresentative sample. Since this sample is drawn from a patient population registered with a medical cannabis company, respondents may be more than likely to report positive furnishings related to the medical use of cannabis—including substitution effect—because of selection bias. All data in this study were self-reported retroactive information past patients and did not benefit from biological drug detection to confirm use or non-utilise of a substance, so is field of study to potential recall bias. Since the questionnaire measured "always" use of drugs and subsequent substitution, there is no way to make up one's mind whether cocky-reported commutation was a temporary or lasting outcome. However, the identification of specific prescription drugs substituted for by respondents partially mitigates this event for this grade of substances, since respondents specifically refer to substitution of an actual prescription drug, rather than a drug class like booze or tobacco. In light of these potential biases, the characterization of the therapeutic utilize of cannabis and/or cannabis substitution effect should exist interpreted with caution pending replication by research that employs a more systematic recruitment approach, longitudinal monitoring, and biological drug testing.

These limitations are counterbalanced by several methodological strengths, including the big size of the sample, assurance that all participants were using a standardized, high-quality source of cannabis with the support of a wellness intendance practitioner, and adherence to established standards for reporting Internet-based surveys [61].

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Acknowledgements

The authors would like to thank all the patients who shared their knowledge and experience with u.s..

Funding

Funding for this written report was provided by Tilray, a federally authorized Canadian medical cannabis product and research company. Data gathering was done on REDCap, a HIPAA and PIPEDA compliant electronic data capture system, and analysis was conducted past researchers with no connexion to Tilray.

Availability of data and materials

The datasets used and/or analyzed during the current study are bachelor from the corresponding author on reasonable asking.

Writer data

Affiliations

1. Social Dimensions of Wellness, University of Victoria, 3800 Finnerty Rd., Victoria, BC, V8P 5C2, Canada

   Philippe Lucas

2. Tilray, 1100 Maughan Rd, Nanaimo, BC, V9X1J2, Canada

   Philippe Lucas

3. Canadian Institute for Substance Utilize Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada

   Philippe Lucas

4. Cleveland Clinic Neurological Found, Department of Neurology, Middle for Neurological Restoration - Headache and Chronic Pain Medicine , 10524 Euclid Avenue, C21, Cleveland, OH, 44195, USA

   Eric P. Businesswoman

5. Principal Research Scientist; Partition of Data Science, Leafly, 71 Columbia Street, Suite 200, Seattle, WA, 98104, The states

   Nick Jikomes

Contributions

PL conceived, designed, and implemented this survey and was the primary author of this manuscript. EB conducted the primary assay, created the tables and figures for the manuscript, and contributed to the manuscript. NJ conducted the preliminary analysis of this information. All authors have reviewed, contributed to, edited, and approved the final manuscript.

Corresponding author

Correspondence to Philippe Lucas.

Ethics declarations

Ideals approval and consent to participate

This survey was ethics reviewed and approved by Advarra (formerly Institutional Review Board Services; reference # Pro00018492), and the University of Victoria later on canonical a post-survey sub-analysis of the commutation data (reference # 17-188). A password-protected link to an online survey bachelor in French and English language was sent out to 16,675 Tilray patients in January 2017. Clicking on the link in the email invitation took patients to the IRB approved Informed Consent Form (ICF), and consent was gathered electronically.

Consent for publication

Not applicable.

Competing interests

This inquiry was supported by Tilray, a federally authorized Canadian medical cannabis production and inquiry company. PL is Global Vice-President, Patient Research and Access for Tilray (world wide web.tilray.ca), and he designed the survey. Formal analysis was conducted by EB, who has no conflict to disclose. Preliminary data analysis was conducted by NJ, Senior Science Advisor, Information & Analytics, at Leafly, an online cannabis website.

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Lucas, P., Businesswoman, E.P. & Jikomes, Northward. Medical cannabis patterns of use and exchange for opioids & other pharmaceutical drugs, booze, tobacco, and illicit substances; results from a cantankerous-sectional survey of authorized patients. Harm Reduct J 16, 9 (2019). https://doi.org/10.1186/s12954-019-0278-half dozen

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• Received: 07 December 2018

• Accepted: 10 January 2019

• Published: 28 January 2019

• DOI : https://doi.org/10.1186/s12954-019-0278-6

Keywords

• Cannabis
• Opioids
• Substitution
• Addiction
• Marijuana
• Harm reduction

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Source: https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019-0278-6

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